FODMAP Diet: A Fad Diet or Helpful for Everyone?

The FODMAP diet is gaining traction on blogs, media and in the research studies. Does that mean that this “newish” idea could help everyone or is it another dreaded Fad diet?

Remember, over 100 years ago researchers thought carbohydrates were the biggest problem for people with digestive conditions. Recent studies are starting to show significant improvement (74%) in digestive symptoms using the FODMAP Diet [1]. Based on that, I think the idea is worth a more in-depth look. So, let’s start with a primer of what you need to know.

What is the FODMAP Diet?

Let’s start with the alphabet soup name: “FODMAP.” It’s a medical acronym for Fermentable, Oligosaccharides, Disaccharides, Monosaccharides and Polyols. Yummy right? The diet portion of the name is in reference to a sequence in which the foods with higher FODMAP content are removed and slowly added back in. First, let’s figure out what those big words mean, then I’ll tell you how they might be hurting you and how to avoid them.F is for Fermentable – In this context, the fermentation of these carbohydrates occurs either in the small or large intestine. In many cases, this is normal and happens in healthy people. But in people affected by IBS the fermentation causes more pain than normal. The theory here is (in affected people) a reduction in all fermentation will improve the quality of patients’ lives.

O is for Oligosaccharides – “Oligo” is a Greek prefix for having few or little and saccharide is another word for sugar. So, this is a word that means short-chain carbohydrates. In the case of FODMAPS, we’re talking specifically about fucto-oligosaccharides (fructans) and galacto-oligosaccharides (galactans). The fructans group is comprised of FOS and inulin. Glacatans are made up of Raffinose and Stachyose (mostly found in beans).

D is for Disaccharides – “Di” meaning two, and again saccharide meaning sugar. So, this word means two sugar molecules linked together. Interestingly, in the case of FODMAPs, researchers don’t believe all disaccharides are problematic… only lactose (milk sugar).

M is for Monosaccharides – “Mono” meaning one, this word is used to describe one basic sugar molecule. In the context of FODMAPs, researchers don’t implicate all monosaccharaides only fructose.

And

P is for Polyols – This is another name for sugar alcohols such as sorbitol, mannitol, xylitol and isomalt. These sugars are malabsorbed by everyone and are free to be fermented by bacteria wherever the bacteria find them. Even healthy people can experience digestive problems from eating sugar alcohols.

I’m sure you’re thinking, “Great but why do I care?” Well, it turns out researchers have found that these specific foods contribute to digestive problems like diarrhea, constipation, gas, pain and bloating.

How Do FODMAP’s Hurt Us?

Simply put, researchers have isolated these foods as possibly harmful for digestion because they all share one specific characteristic: they are poorly absorbed in the small intestine. [2] If they aren’t absorbed properly then they can hang out too long in the intestines and become a feast for bacteria, which is where the “F” for fermentable comes into play.

As the bacteria ferment the nutrients, their waste products affect us. This can increase intra-abdominal pressure causing both stomach pain and reflux problems. [3] It is thought that some of their by-products activate a feedback loop that regulates gut motility, accelerating small bowel transit times. [4] There is also an increase in osmotic load (or more water delivered to distil small intestine and colon) due to the size of some of molecules. [5]

The thought is that if we increase the speed, pressure and amount of water delivered to the colon it will cause more digestive problems. And with a 74% rate of success in people who stop eating these foods, it sure seems that this is an extremely helpful idea for some people with digestive problems.

Do You Have FODMAP Intolerance?

The researchers acknowledge that the FODMAP diet doesn’t cure anything but it can provide great symptom relief. So, how would you go about determining if you’re someone who is reacting to FODMAPs and could benefit from avoiding foods with higher FODMAP content? Test removing them and then add them back in.

At the core of our message, here at SCDlifestyle, is that every food should be tested. And foods containing higher amounts of FODMAPs are high on the list of foods that should be tested if you’re still experiencing digestive problems even after eliminating grains, starches, and sugars.

Step 1 in testing FODMAP intolerance is to remove foods with high FODMAP content, which includes:

Is The FODMAP Diet a Forever Thing?

No, in fact it wasn’t ever thought of as a long-term solution. This is something that many people aren’t talking about. But Step 2 in this diet is to add the foods back into your diet. Here’s what one of the most recent studies in 2012 had to say:

“A trial of a low FODMAP diet can be conducted. This is usually recommended for 4-6 weeks, following which, a rechallenge of any potentially well-absorbed carbohydrates can be undertaken, that is, fructose, lactose, sorbitol and mannitol. Tolerance to fuctans and GOS [galactans] can then be tested.” [6]

Sounds like these researchers believe the same thing we do, which is that every food has the potential to harm depending on the health of the body or the quantity consumed. It’s worth noting that in my review of the FODMAP literature it was commonly referred to as a diet to provide symptom-relief, not curative.

I think they are learning what we have, which is that everyone has a custom diet and that diet will change depending on the health of the GI tract. In fact, here’s another quote from that study:

“In addition, FODMAPs have prebiotic effects due to the production of short-chain fatty acids after fermentation. Therefore, all patients are encouraged to try and reintroduce FODMAPs to a level that they can comfortably tolerate.”

We know that short-chain fatty acids can be very beneficial to the colon. And there are many proponents of prebiotics to help with digestive disorders. But beyond that most of the FODMAP vegetables and fruits aren’t filled with toxins so they shouldn’t be labeled as bad foods.

Our Personal FODMAP Experiences

Personal experience can always trump theories. So at this point, I’m sure you’re curious to know if we’ve tested FODMAPs.

I noticed minor reactions to some higher FODMAP foods the first time I tried them. Onions, broccoli and cauliflower didn’t sit well at first, but a few weeks later, I used the same gradual introduction techniques we teach now and did just fine with smaller doses. I continue to handle them just fine.

Jordan was as FODMAP sensitive as they come his first year on the diet. In fact, he couldn’t even eat a cup of cooked broccoli. He couldn’t do garlic or onion either – not even a small bit for flavor without noticing some violent reactions. Three years later, he’s able to tolerate those foods just fine. I’ve even seem him mash several high FODMAP foods in one sitting like apples, asparagus and avocados.

So, was it the FODMAP foods? Coincidental? Something else?

The FODMAP Paradox

Paradoxically, many people will see short-term relief by removing high FODMAP foods, but most can add those back only weeks later with no problems. So, what is going on here?

In our experience, we think a few factors are at play. The first is the additive effect. If your diet contains small amounts of all these FODMAP foods eaten daily and then you cut them all out, it’s likely you’ll notice some relief but it’s also likely that you’d be able to eat some of those foods in small quantities each day and not have problems.

Instinctually we should know this (but I often forget it); after all it is universal to all foods, not just FODMAPs. We have an upper tolerance to everything we eat… Eat 10 bananas, 5 cups of broccoli or 10 cups of spinach and you’ll spend equal time on the toilet for each one of those transgressions. It seems that the tolerance for FODMAP foods is just lower in susceptible people.

The second factor seems to be gut health. After a washout period of removing high FODMAPS, high salicylates, and other toxic foods, people’s tolerances to all food improves almost universally. Why? Maybe it’s the SIBO connection, gut flora rebalancing, pathogen killing or decreasing the inflammation levels for a few weeks that allows some healing to take place. I don’t think anyone can say for certain right now, but I believe the relative health of the gut is the most important factor in food tolerance.

In summary, if you think FODMAP foods might be triggering your digestive symptoms here’s how to find out:

Step1. Remove high FODMAP foods for 4-6 weeks and track your symptoms during this time

In the future, we’ll explore how our gut flora changes in response to what we eat. But I think most people can handle FODMAPs if they’re eating a low-toxin diet, their overall diet isn’t extremely FODMAP heavy, and then they slowly re-introduce them.

Have you tested high FODMAP foods? I’d love to hear your experience below in the comments.

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About the author

Steve Wright is a health engineer and author. In 2009, he reached a breaking point when IBS took over his life and the doctors didn't know how to help. Since then, he has transformed his health and started SCDLifestyle.com to help others naturally heal stomach problems. You can check out his story here and find him on Google+, Facebook or Twitter.

Thanks for the amazing webcast broadcast a few weeks ago! Very helpful info. My question is if you take a food that’s high in Polyols such as cauliflower and culture it, are the natural sugars in that food “eaten up” allowing a person who would normally react to it to be able to eat it?

Hi Sharon – in Theory yes. Fermenting the food will make it easier to digest and many will find they can tolerate foods better that way. Of couse, there are those that do not tolerate fermented foods too, so you just have to test out a small amount ans let your body decide:)

I was diagnosed with IBS at age 17, and have had digestive issues for 15 years. Last year the symptoms became unbearable and were more than just typical digestive issues. I was fatigued, had muscle aches, skin problems, an autoimmune condition, recurring infections, bladder issues (which were never explained), I became sensitive to many foods and there were points where I could barely stomach anything, sweating and night sweats, chronic inflammation….I was a mess. I spent a year researching my condition looking for an answer because I believe all of these things were connected. Long story short, I was finally diagnosed with SIBO (Small intestinal bacterial overgrowth) and discovered that a huge percentage of people with IBS actually have this and can get tested and diagnosed. Ten years ago this was not possible. SIBO affects so many different parts of your body and health, and by the time I was diagnosed I was losing weight (already underweight) despite eating excessively all day to try to stop the weight loss. My body was not absorbing nutrients because either a rupture in my intestinal lining was causing nutrients and toxins to leak out, or everything i was eating was only feeding the bacteria in my small intestines. IBS is not an imaginary syndrome, it is a disease and research is showing that it can lead to many other conditions. Doctors are failing us because they rarely test for SIBO. Many doctors turns patients away, chalk it up to stress, perform all the other invasive procedures that don’t even reach that part of your intestines, or simply tell you your imagining it. This is very damaging. My third doctor didn’t want to test for SIBO, she thought I didnt have it. I insisted, and my numbers were off the charts. I havw a severe case. My doctor also did not give me information on this condition and I had to seek the help of a naturopath. If anyone is reading this. Don’t give up, it’s not in your head and we all deserve answers and a chance to be healthy. Research research research, and look up Dr. Siebecker who has spent her career treating and studying SIBO and IBS. I am now learning to manage and treat this condition, and even though the journey will be long, at least now I know what I’m supposed to do instead of stumbling around in the dark.

Hi Lewis – thanks! We recommend everyone start with the Intro diet and introduce foods one at a time – you can skip over introducing high FODMAP foods. Our book explains how to do the diet: http://scdlifestylebook.com/

That’s helpful i’ll make sure to include intro then and look into getting the book – just pumping myself up at the moment before I take the plunge! right now I cant tolerate fat above 5g per meal, so its going to be a struggle in the early stages and a bit of a catch 22 situation if I have to limit veg too! but hopefully my fat malabsorbtion will improve quickly.

I have been following paleo, scd, and low fodmap since 12/2012 for relief of celiac and active ebv in 2012. I have also been treated for sibo 2x. It comes back but I’ve been supplementing with betaine to control it. My chronic fatigue and muscle pains since the ebv were finally heard by my celiac dr who tested me for carnitine. Total and free were 20% below normal low. Supplementing with carnitine has changed my bm’s all for the best and I can now eat more fodmap veggies. Can you offer reasoning for this and also what type of medical dr can help me. I believe I have some type of lipid storage / metabolism issue.

Hi Stacey, thank you for reaching out! My best suggestion is to reach out to one of our practitioners here, who would be more than happy to get to teh bottom of this for you: http://scdlifestyle.com/practitioners/

Hi, I tried the FODMAP diet,Elimination diet through an Allergist, my own elimination diet, a diet with the help of a Nutritionist, testing food after food and getting confused results, this whilst literally starving myself trying to get well.
Eventually after 5 years I found i had SIBO and was treated for it. I had been tested for SIBO before but after talking to people on Facebook I found out the breath test i had wasn’t done for long enough ( it should be for 3 hrs) and so the test came back negative. I am on SCD now and getting well. I am a Coeliac and have found i do well on NO carbohydrates, except in vegetables. I don’t understand why this si but i don’t need an answer to it anymore, the important thing is I am beginning to feel well and am eating the important FODMAP foods again that re populate the gut, garlic and Saurkraut and slowly adding onion. My advise is make sure you are not harbouring SIBO before you try and find out what FOOD is making you sick. you can get well, keep demanding tests, tests and more tests. 🙂

Can you tell me how your SIBO was treated? I am in the same boat as you were, I was given the 2 hour test, and all my doctors say if I had SIBO the test would have picked it up. My current doctor is giving me some herbals that he thinks will clear up any infections I have. I am soooo tired of not being well and no medical professionals that know enough to help me! Did you use Rifaxamin? And did it heal you completely with one round? I can’t even eat kale or zucchini. I am living on 4 different meats, fat, and bok choy, and have been for the last 4 months. Thanks for your help.

I’d like to echo Delandra’s question about apples and pears above. I’m on day 2 of the Tough Case meal plan after 3 months of getting nowhere on Autoimmune Paleo. I suspect SIBO and/or parasites, and will be meeting with Stephanie Davis next week for testing. In the meantime, I noticed that pears start on Day 6. I’ve suspected FODMAP intolerance and am nervous the pears and apples will make whatever condition I have worse.

Do you recommend proceeding with the meal plan as as currently laid out? Can gut health improve on this meal plan even if you have FODMAP intolerance, or will I be spinning my wheels even longer? If the latter, are there recommended substitutes for the high FODMAP items on the Tough Case plan?

I had the same concern when I used the tough case meal plan. However, I blindly trusted it (eating the large quantity of pears) and ended up feeling awful. I have SIBO and do not handle any FODMAPs. I also seem to have fructose malabsorption because I cannot eat any fruit (except maybe 10 raspberries) without having a reaction. I have found that and Autoimmune Paleo approach combined with SCD and Low FODMAP to be the most helpful for my symptoms. It is incredibly restrictive, but made my digestive system feel better. You might also want to check out my blog: sibowithhope.wordpress.com

We did low FODMAP for two-plus years trying to figure out my son’s chronic constipation issues. That combined with Miralax (a synthetic sugar alcohol) basically acted like fuel for certain bad bacteria, while starving certain good bacteria (the ones who like prebiotics, the obligate anaerobes). So about two months ago, we had a diagnosis of Crohns.

I have to say, after over a month on SCD, we’re finally introducing some higher FODMAP fruits and garlic, and my son is tolerating them a-okay. It’s so nice after having to be really restrictive with fruits for so long. It blows my mind that it’s “not a long term diet”. I really wish I had known that from the beginning.

Hi misspudding,
I am 24 years old but have been struggling my whole life with constipation. I was tested once for Crohns but that was a few years ago. I figured it wasn’t possible since constipation usually isn’t a symptom of Crohns. Ive tried Miralax and that did not help at all. Did you find SCD diet better than fodmap? I am thinking maybe I should be retested for crohns?

Currently trying to work out what causing my little boy (aged 5) digestive problems. We’ve been dairy free, egg free, wheat free and then gluten free….. still no improvement. Purely by accident we had a good week and realised that it was a week that was low on fruit, veg and sugary things. From there we’ve found out about FODMAP. The dietitian we are under isn’t trained in FODMAP and I don’t want to wait as we work our way through the NHS system (currently waiting for a gastro appointment and then from there guess we’d get a more qualified dietitian). We’d like to get on with the FODMAP elimination diet asap – semi doing it now, but want to do it properly. Generally I get it, but where can I get the 4 day gradual re-introduction explained. Also, is there any other resources for the FODMAP elimination diet that you would recommend. Many thanks!

Been on fodmap diet since Sept 7 2013. Also lactose intolerance. Feel great not bloated anymore no pain. Lost 12 pounds. I’m 57 went from 126 to 114 Doctor says to stay on fodmap. Tried to put in foods I Allways eat. And I felt like I was going to die. Is is safe to stay on diet?

Please email me directly with your response as I won’t be able to check blogs or the webpages where you post people’s comments. Question: Why would apples and pears be “legal” on the SCD diet since they are very high in fructose & are also not recommended in the IBS FODMAP?

Hi guys,
I recently experienced an IBS flare and couldn’t get it under control. After trying every diet out there, the only one that helped almost immediately was the FODMAP. The only thing I did wrong was, as soon as I begun to feel better; I went hog wild and added too many things at once to my system. Voila! Within days I was sick again.

Anyway, back on it again and will reintroduce things very slowly this time. My theory is that although I was feeling better I must not have had enough good flora built up and my system became overwhelmed fairly quick.

Just a clarification. FODMAP’s doesn’t allow lactose, so lactose free milk and lactose free yogurts are allowed, unless a person has an allergy or intolerance to the casein and whey proteins in the milk. Kate Scarlata, RD keeps her website and blog up to date with the new foods being tested by Monash University. Almond milk has not been tested yet, but people have reported having problems with it, so it will be interesting to see how this one rates.

Hey, idea for you…why not create an SCD plan that is low in FODMAPS as Liz mentioned she is doing…FODMAPS at the end of the phases as an option to the meal plans you have? I’d like to do this but am too overwhelmed to figure this out. I’d pay for that!! Especially if it was aligned with the latest edition of legal foods from Monash Univ. It’s be super helpful for those of us trying to do SCD and have FM. Just an idea for you to ponder! 🙂

There is a simple SCD low FODMAP eating plan lined out – it’s at Dr. Allison Siebecker’s website – http://www.siboinfo.com She’s awesome; the information on her website is invaluable. And, I think it’s working for me. Slowly, but surely, I’m making progress on my SIBO. I am nowhere near fully healed, but making progress and I’m going to take my small victories where I can and not drive myself insane with questioning and worry.

basic question – there are many contradictions between FODMAP and SCD -for example – sugar vs honey, rice, potatos etc…. – as one looking for the most suitable diet for fighting crohn – which guidance to use…?

Ok, sorry for the questions but still in research mode. I keep coming back to this website. I eat a paleo plan and am totally gluten and dairy free. I still have chronic “runs” and have started on FODMAP plan. So my question is that you are about creating an eating plan on scd that fits you. Does that include holding off on adding FODMAPS back in till the very last phase? I am purchasing your books and cd next week after I return from business trip…. Thanks for your help!

I want to rule out parasites and SIBO, but it seems that tests don’t always diagnose properly. Especially parasites. I’m thinking I should just do a parasite cleanse with ParaGone and diatomaceous earth without a diagnosis. And perhaps a liver cleanse?

I have been on the GAPS diet for two years and seen great improvement, but I have some lingering symptoms: bloating after eating dairy, fruits, or vegetables; eczema on my leg and head; extreme fatigue after eating dairy or sweets. (Gluten, too, but I don’t ever eat that).

My bristol chart is #4 and my blood, urine, and hormone tests came back spectacularly good, so I must be absorbing my food. Yet I can’t shake these last few symptoms.

I’ve also been trying a combination of SCD/GAPS and FODMAPS for SIBO, talk about elimination! Trying to work out the kinks and slowly bring back in foods. I’m curious about your mentioning being tested for yeast overgrowth. Do you have advice onthe best way to do this?

I follow SCD without FODMAPS and it is very restrictive, but I do see some improvements towards tollerance levels slowly. I do believe as you, Steve and Jordan, that the intestines needs peace and quiet for a while, and then that it is possible with recovery. I am eating some FODMAPS everyday, but try to keep the level as low as possible. i sure think there is a connection with IBS and intollerances.

@Vibeke – You’re doing great! Make sure you get tested to rule out parasites, SIBO or Yeast overgrowth because while you’re doing amazing on the food front many of these underlying causes won’t be impacted.

When my GI told me I had severe gastritis and to come back to him every year for an endoscopy to check for stomach cancer, but because PPIs made my reflux worse and my colon was beautiful, he sent me to a nutritionist and suggested I also check in with a psychologist because he actually told me I was imagining and then causing my symptoms of reflux, bloating, gas, and diarrhea that occurred after every meal. First the nutritionist tried a slight reductions in my FODMAPs but that didn’t change my symptoms. Then, after seeing her a few times, we went on a major FODMAP elimination diet. The only foods I ate were fish, eggs, gluten-free low-fiber (i.e. no brown rice) grains, citrus, small amounts of blueberries, spinach, kale, carrots, bok choy, string beans, tomatoes, bell peppers, maple syrup, table sugar, and oil. That was it. For three weeks, I felt so much better. My near constant reflux was still there, but gas and bloating was minimal and I was down to one, occasionally two, formed BMs a day. The handout my nutritionist gave me listed these foods and at the bottom said that the complete elimination diet was not sufficient nutrient-wise and should only be followed for 1-2 months, at which point I could start adding back in slowly the nutrients I was missing. But she soon proved to be incompetent as a professional and I never heard from her again. And at the end of three weeks, the diarrhea came back in full force over the course of a few days. I chalked it up to PMS and waited it out but my symptoms stayed to the point where I was back to occasionally having BM accidents when the pressure of gas and bloating got to be too much. Even though my symptoms were still there, I stayed on the minimum FODMAP diet for a year until I went to a new GI and nutritionist. In fact, my symptoms had gotten so much worse. Early on in the FODMAP journey and before, if I had a bad day, I could fix it with either medication or eating nothing but white rice for a day, depending on which was easier. But now I noticed that white rice was having zero effect on how I was feeling and I felt like I was starting to feel even worse with corn flours and white potatoes. While they figured out my history and waited for bloodwork, the nutritionist suggested I return to a full diet since I thought I couldn’t feel any worse to see what would happen. Well, excited about summer fruits, I started eating half a stone fruit with breakfast or on a different day, having a small amount of eggplant with dinner, and various other things in small amounts, spread out. Like clockwork, these FODMAPs food that were hiding in my diet before with no clear connection to my symptoms, caused the most horrible gas I’d ever had (like, my dogs find it offensive, have to change my pants from the smell kind of gas). While I’d had episodes that bad before, they didn’t occur daily or within hours after a FODMAP meal and I used to eat a lot of bananas and onions at least once a day, among many other FODMAPs. So basically somehow after this year of FODMAP elimination, I’d made my body more sensitive, either by eliminating them or by having a diet that caused whatever damage the previous GI couldn’t find worse. So I went back to the no FODMAP diet and was diagnosed with SIBO. 2 months of metronidazole and probiotic/caprylic acid/oregano oil and supposedly I was cured of SIBO even though my symptoms hadn’t changed throughout. Reintroduce the FODMAPs and right back to bad gas. So the nutritionist handed me BTVC and said to keep this in the back of my mind because she still had a few things she wanted to try and she tried to keep SCD as a last resort kind of thing due to its restrictiveness. However, I’d first heard of SCD in my own research at least two years prior and it had been in the back of my mind since then. I always considered it restrictive but having spent the previous year following my no FODMAP diet with anaphylactic vigilance at home but also with friends and in restaurants, suddenly it looked gluttonous with choices. I started SCD right away. Fast forward to six weeks into the diet, and I’ve rearranged the phases to have all the high FODMAPs at the end. All my symptoms are decreasing, albeit erratically. The only FODMAPs I’ve introduced so far are bananas, avocados, and squashes (I never ate them before because I wasn’t supposed to be eating sweet potatoes on my no FODMAP diet and I always equated them as similar). I really and truly hope that I can reintroduce them because I told my nutritionist that the only way I considered SCD restrictive would be if I had to follow SCD with no FODMAPs. I can mentally handle doing small amounts of FODMAPs, but to not be able to go near them would be too tough. Also, I was so excited when my symptoms decreased that I started to hope that I was fixing (not just relieving the symptoms) whatever is my problem and started canning peaches, nectarines, and plums like there was no tomorrow and am about to start doing the same with applesauce because if I decide I want to try a FODMAP food in February, I want those beautiful fruits that I longingly passed by this summer. Sorry for such a long-winded response but long story short, no, my body is telling me that the idea of FODMAPs are not a fad at all, but a FODMAP diet is kind of useless on its own, especially when you’re told that rice and potatoes are safe. But FODMAP principles combined with SCD/GAPS principles seems to be the way to go (hopefully).

@Liz – wow I’m so impressed with you’re relentless drive and desire to get healthy. You need to be commended for that! Sounds like you got the food thing down very well. Make sure you rule out other things like parasties and low stomach acid. And keep us updated on your progress!

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